QuestionQUESTION: i m about 20 years old ..trying to concieve two years are gone...doctors told me i have immature follicle and on after every cylce i used medication including clomid , ovarine f , cerophene etc on specific dates changing the medications each time ...and every time on 13 th 14th day doctors told me the follicle size is normal but no results...what is the matter ...what should be further treatment
ANSWER: Dear Anum,
First, there is no such thing as "immature follicles" as a clinical diagnosis. Immature follicles are found in the ovary if examined pathologically or by ultrasound but that is because those follicles have not been stimulated to mature yet. A woman stimulates and matures a follicle each cycle. In the meantime, the immature follicles that were not stimulated just and sit and await their turn. "Immature follices" is not a cause of infertility.
If you are not ovulating, then that is a clinical diagnosis and cause of infertility. In that case, you would require fertility drugs to stimulate your ovary and induce ovulation. We can that an Ovulation Induction cycle. Various medications can be used, but in general they are successful, especially in a 20 year old. If you have not been successful, then maybe you are not seeing the right specialists. In order to be successful, the doctors treating you have to know what they are doing, just as in all things.
If you are undergoing ovulation induction then have intercourse, that is called an "ovulation induction cycle with timed intercourse" cycle. In that case, it is pretty close to trying on your own. It takes several months of trying to become pregnant naturally and it is the same with this type of treatment. It is not magic. You have to be patient and keep trying. If that does not work, then you have to move to the next level of treatment, or undergo a complete infertility evaluation (assuming you have not already done so).
I hope this helps,
Edward J. Ramirez, M.D.
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
Monterey, California, U.S.A.
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QUESTION: ok u mean i am not ovulating what should be the drugs to use...
i was also injected hmg hormone on 3 particular days on two cycles and also gonadorphin (not know spelling)....
and test showed i have high amount of male hormone .....
another doctor told i have insulin / hormonal imbalance and i used melformin /glucophage for about 2 months....but i have not cysts in uterus
i m getting depressed ...and i have physical problem like facial hair and acne too...and my breast size is below normal
AnswerHi again,
It sounds like you have an ovarian disorder called "Polycystic Ovarian Syndrome". In this disorder, the ovary is not processing the hormones from the brain correctly so it does not ovulate. As a consequence, the female hormones are not created and instead, male hormone is created which leads to the acne, facial hair, male pattern baldness and increased weight gain. In order to get pregnant, you have to use fertility medications to stimulate the ovary. There are various kinds, and are variable in their strengths. They are as follows:
Clomid - pill form, easiest to use, not all PCO patients respond to this. Can be used from 50-250 mg per day.
Gonadotropins - this is a category of drugs that include HMG, FSH, Gonal-f, Follistim, Bravelle, Menopur, pergonal. These are very strong drugs and must be taken as injections. You have to be closely monitored because PCOD patients are notorious for over-stimulating leading to the production and ovulation of 10+ eggs.
In your condition it is imperative that you see a fertility specialist, not a general GYN doctor. You need a clear treatment plan and need to be monitored closely.
In my patients, I will usually try Clomid 250 mg per day first. I use the ultrasound to monitor the progress so that I will know if you are responding and when you are ready to ovulate. I then give an injection called HCG (Ovidrel) to trigger ovulation. If you don't respond to this then I know that I have to go to stronger medications.
I will usually recommend proceeding to IVF from here because it is too difficult to induce ovuation with the gonadotropins in PCOD patients. They end up producing too many follicles to ovulate and we have to cancel the cycle. With IVF it doesn't matter because we can extract all the eggs and only transfer two or three back into the uterus.
If your insulin level is elevated, which occurs in approximately 50% of PCOD patients, then Metformin is the drug of choice. It will take 6-8 months before taking effect so you have to be patient. In some patients, it will correct the ovarian problem and you will begin ovulating spontaneously.
I hope this answers your questions.
Edward J. Ramirez, M.D.
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
Monterey, California, U.S.A.
